Abstract: TH-PO1189
Metabolic Acidosis and Growth in Pediatric Patients with CKD: Evidence from Electronic Health Records
Session Information
- Pediatric Nephrology: CV Health, CKD, AKI, Dialysis, Transplantation, and Health Services Research
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1800 Pediatric Nephrology
Authors
- Brown, Denver D., Children's National Hospital, Washington, District of Columbia, United States
- Adetunji, Fiyinfolu, Children's National Hospital, Washington, District of Columbia, United States
- Chandereng, Thevaa, Children's National Hospital, Washington, District of Columbia, United States
Background
Linear growth (i.e., height) impairment is a known consequence of chronic kidney disease (CKD) that has been associated with adverse clinical and psychosocial outcomes. Highly selected cohort data suggests an association between metabolic acidosis (MA) and worse linear growth. In this study we used robust, longitudinal electronic health record (EHR) data to provide real work evidence for whether MA associates with linear growth in children being treated for CKD.
Methods
The study population comprised children receiving Nephrology care across 12 institutions included in the PEDSnet EHR Database. Children included were: 2-18 years old at the index visit, who had a diagnosis of CKD diagnosis stage 1-4 (based on diagnosis codes or estimated glomerular filtration rare, eGFR) who had at ≥2 serum bicarbonate values as well as ≥2 height measurements during follow-up. The primary exposure was Low serum bicarbonate dichotomized as <22mEq/L (low; a surrogate for MA) or ≥22mEq/L (normal). The primary outcome was linear growth (cm and z-score). The follow-up period was defined as 5 years from the index date. Linear mixed model with repeated measurement and adjusted for age, sex, race, and eGFR were used to assess for differences in linear growth between the MA and normal bicarbonate groups.
Results
The study population was comprised of 3,210 children. At the index (i.e., baseline) visit, the mean age was 11 years, there was a male and Caucasian predominance, 250 (14%) of the population had a serum bicarbonate of ≤22mEq/L with only 24 (0.7%) of these patients reporting treatment with alkali therapy. Additionally, low serum bicarbonate was associated with significantly lower height and eGFR measurements. During the follow-up period, in longitudinal models low bicarbonate (<22mEq/L) compared to normal bicarbonate was associated with worse height and height z-scores despite adjustment for clinical covariates, (-2.50, 95%CI: -3.90, -1.10 and -0.23, 95%CI: -0.41, -0.04, respectively).
Conclusion
MA was associated with worse height measurements at baseline and during the follow-up period. Planned future directions include adjustments for bone specific covariates such as calcium/phosphate/vitamin D status as well as analyses to study whether treatment of MA with alkali therapies modifies growth outcomes.
Acknowledgment
The PEDSnet study
Amerocan Society of Nephrology Foundation, Kidney Cure
Funding
- Private Foundation Support